Carboplatin and etoposide

Carboplatin and etoposide are chemotherapy drugs you have together.

You pronounce carboplatin as car-bo-pla-tin. You pronounce etoposide as ee-top-o-side.

You might have them as a treatment for a number of different cancer types.

How does carboplatin and etoposide work?

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How do you have carboplatin and etoposide?

You usually have carboplatin and etoposide into your bloodstream (intravenously). 

You might also have etoposide as capsules. They are pink in colour. You take them on an empty stomach with a glass of water.

Into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

Risk of tissue damage

When you are having this treatment through a cannula it could damage the tissue if it leaks out of the vein. This is called extravasation. This can happen anywhere along the vein that the drug is going into. It doesn’t happen very often. Tell your nurse straight away if you notice any changes such as swelling, redness, pain, burning, or a stinging feeling.

Your nurse will stop the drug treatment. And they will treat the area to relieve symptoms and reduce tissue damage. Contact your healthcare team if you develop any of these symptoms when you are at home.

Taking your capsules

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking or miss a dose of a cancer drug.

Talk to your specialist or advice line before you stop taking a cancer drug.

How often do you have carboplatin and etoposide?

You have carboplatin and etoposide as cycles of treatment. This means that you have the drugs and then a rest to allow your body to recover. Each cycle of treatment lasts 3 weeks (21 days).

Depending on your cancer type you may have between 4 and 6 cycles.

This is one way of having carboplatin and etoposide.

You then start a new cycle of treatment.

Some hospitals may also give you G-CSF to take. This is an injection under your skin and helps the body produce white blood cells to reduce the risk of infection.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of carboplatin and etoposide?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 (more than 10%). You might have one or more of them. They include:

Increased risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Bruising, bleeding gums or nose bleeds

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae).

Less commonly you might bleed from other areas of the body. Tell your medical team if you notice any bleeding.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Tummy (abdominal) pain

Tell your doctor or nurse if you have this. They can check for the cause of the pain and give you medicine to help. 

Loss of appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Feeling generally unwell

Speak to your doctor or nurse if you feel generally unwell after taking these drugs.

Tiredness and weakness

You might feel very tired and as though you lack energy.

Various things can help you to reduce tiredness and cope with it, for example exercise. Some research has shown that taking gentle exercise can give you more energy. It is important to balance exercise with resting.

Changes in the levels of minerals, proteins and enzymes in your body

Your blood contains different levels of minerals, proteins and enzymes. This treatment can change the levels of calcium, phosphate, magnesium, sodium, potassium, creatinine, and urea in your blood.

You have regular blood tests to check for any changes in these levels. 

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Skin changes

Areas of your skin may get darker or lighter. This usually gets better after treatment finishes but occasionally it can be permanent. Let your doctor or know if this happens.

Less common side effects affecting the skin include a rash, dry and itchy skin or sensations of burning, prickling and hives.

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a laxative if needed.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness. Some allergic reactions can be life-threatening. Contact your treatment team if notice any of these symptoms.

• blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms.

• a serious reaction to an infection. Signs can include feeling very unwell, not passing urine, being sick, a very high or very low temperature or shivering. Contact your advice line straight away if you have any of these symptoms.

• a heart attack. You’ll be closely monitored when having this treatment.

• changes to the way your heart works, including an irregular heartbeat. Your doctor will do tests to check for this.

• difficulty breathing due to tightening or inflammation of the lung tissue. Symptoms include shortness of breath, cough, wheezing or tightness of the chest. Let your nurse or doctor know straight away if you have this.

• numbness and tingling in your arms, hands, legs and feet

• inflammation around the drip site which can cause pain and swelling

• low or high blood pressure

• dizziness

• inflammation of the veins

• sore, inflamed mouth and throat

• a blood cancer called acute leukaemia

• kidney damage. You have blood tests before treatment to check how well your kidneys are working.

• diarrhoea

• changes to taste including a metallic taste in the mouth

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include:

• nerve damage causing soreness, pins and needles in the hands and or feet

• difficulty swallowing

• feeling sleepy

• seizures (fits)

• swelling and enlargement of the breast tissue that can be painful. This mostly affects men.

• hearing changes that might cause ringing in the ears (tinnitus), part or total hearing loss in one or both ears and feeling of fullness in the ear

Other side effects

The following side effects have also been reported. But it's not clear how often they happen. You might have one or more of them. They include:

• general swelling including the mouth and tongue

• changes to your eyes and eyesight

• high levels of chemicals in your blood due to the breakdown of tumour cells (tumour lysis syndrome). You will have regular blood tests to check for this.

• a decrease of the blood flow to the fingers and toes

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, foods and drinks

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Pregnancy and contraception

This treatment may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for at least 6 months afterwards.

Women must use reliable contraception during treatment. Men must use reliable contraception during treatment and for at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Breastfeeding

Don’t breastfeed during this treatment. This is because the drugs may come through in your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.